Episodes
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How can new tools help you be successful in sinus surgery? In this episode of the BackTable ENT Podcast, Dr. Peter-John “PJ” Wormald, Chair of Otolaryngology at Adelaide and Flinders Universities, delves into the complexities of frontal sinus surgery and innovative solutions for common surgical challenges with hosts Dr. Ashley Agan and Dr. Gopi Shah.
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SYNPOSIS
The surgeons discuss chronic frontal sinus disease, when to consider surgery, and optimal post-operative care. Dr. Wormald shares his surgical strategies, including the use of innovative technologies like Chitogel and 3D CT planning software for better surgical outcomes. He also touches on the challenges in training new surgeons and the potential for advances in medical simulation to improve surgical education. This thorough discussion offers insights into the latest techniques and innovations in sinus surgery.
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TIMESTAMPS
00:00 - Introduction
03:46 - Understanding Chronic Frontal Sinus Disease
07:57 - Approach to Sinus Surgery
13:27 - Antibiotic and Steroid Use in Sinus Treatment
18:23 - Patient Consultation and Decision Making
22:51 - Training the Next Generation of Surgeons
36:29 - Analyzing Surgical Factors & Predicting Surgical Outcomes
47:37 - Post-Operative Management
59:02 - Biologics and Long-Term Care
01:07:42 - Innovations in Surgical Training & Final Thoughts
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RESOURCES
BackTable+ for ENT
https://plus.backtable.com/pages/ent
PJ Wormald Profile
https://researchers.adelaide.edu.au/profile/peterj.wormald
Free Stryker Software for Windows
https://www.dropbox.com/s/r4sodtqv221c5yk/Stryker%20Building%20Blocks%203.6.0%20Windows%20Setup%20-%20FESS%202022.exe?dl=0
Free Stryker Software for Mac
https://www.dropbox.com/s/0iac9pmzdz0lqkz/Stryker%20Building%20Blocks%203.6.0%20macOS%20Setup%20-%20FESS%202022.dmg?dl=0 -
What does it take for a physician-leader to thrive in today's healthcare landscape? In this episode of the BackTable ENT Podcast, Dr. Sunil Verma has an inspiring conversation with host Dr. Gopi Shah about medicine, leadership, and personal growth. Dr. Verma is a laryngologist, Associate CMO of Ambulatory Care, and Associate Dean at UC Irvine Health.
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SYNPOSIS
Dr. Verma shares his journey from clinical practice to holding health system level positions. He discusses the importance of physician leadership, adapting to evolving healthcare systems, and finding personal and professional fulfillment. They also delve into challenges like balancing administrative and clinical roles, the impact of virtual meetings, and the essential need for support within medical teams. Dr. Verma offers insights on making a positive impact within health systems while maintaining personal well-being and growth.
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TIMESTAMPS
00:00 - Introduction
12:41 - Balancing Clinical and Administrative Roles
15:16 - The Importance of Physician Leadership
20:49 - Support Systems and Personal Growth
23:40 - Impact of Physician Leadership on Health Policy
25:43 - The Evolution of Health Systems
33:02 - Physician Burnout and Retention
40:45 - Adapting to Virtual Meetings
44:11 - Advice for Aspiring Leaders
50:45 - Final Thoughts and Pearls of Wisdom
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RESOURCES
BackTable+ for ENT
https://plus.backtable.com/pages/ent
Dr. Sunil’s UCI profile
https://www.ucihealth.org/find-a-doctor/v/sunil-verma -
Episodes manquant?
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As a physician, how would you like to be treated as a patient? A simple shift in perspective can improve both patient care and the medical system at large. In this episode of the BackTable ENT Podcast, hosts Ashley Agan and Gopi Shah are joined by Dr. K.J. Lee, a renowned otolaryngologist, educator, and health policy advisor.
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SYNPOSIS
The discussion covers Dr. Lee’s journey into health policy and advocacy, his experiences with political figures like Barack Obama, and the importance of compassionate patient care through his concept of ‘The Patient is U’ (TPIU). Dr. Lee shares insights on the intersection of healthcare and politics, addresses challenges in the current medical system, and emphasizes the need for empathy and good stewardship in medical practice.
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TIMESTAMPS
00:00 - Introduction
03:39 - Dr. Lee’s Journey into Policy and Advocacy
11:46 - The Role of Otolaryngologists in Leadership
15:14 - Practicing TPIU: Treating Patients as You Would Want to Be Treated
20:20 - Dr. Lee’s Early Influences in Malaysia
29:32 - Healthcare Economics and Quality
31:48 - Complexities in Healthcare Decisions
36:31 - Reflections on a Medical Career
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RESOURCES
BackTable+ for ENT
https://plus.backtable.com/pages/ent
Official TPIU Organization Link
https://tpiu.org/about/
TPIU
https://tpiu.org/k-j-lee-md-received-the-2024-distinguished-service-award/ -
Can technology improve the accuracy of parathyroid tissue identification during surgery? In this episode of Backtable ENT Podcast, Dr. Gopi Shah and Dr. Ashley Agan welcome Dr. Michael Singer, an otolaryngologist specializing in minimally invasive parathyroid and thyroid surgery at Henry Ford Health in Michigan.
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This podcast is supported by:
Medtronic ENT
https://www.medtronic.com/us-en/healthcare-professionals/medical-specialties/ear-nose-throat.html?cmpid=Vanity_URL_MIX_medtronicent-com_202212_US_EN_NS_ENT_FY23
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SYNPOSIS
First, Dr. Singer discusses various aspects of identifying parathyroid glands during surgery, differentiating between hypoparathyroidism and hypocalcemia, and the impact of concurrent thyroid disease on patient outcomes. He highlights the importance of continuous improvement and being open to new technologies, specifically the use of autofluorescence and fluorescence imaging to enhance surgical accuracy and patient safety. The conversation also addresses the practical applications of these technologies, including the Medtronic PTeye parathyroid detection system, and their potential to change the approach to thyroid and parathyroid surgeries. Throughout the discussion, Dr. Singer emphasizes the importance of being honest with oneself as a surgeon in order to improve skills and provide the best care for patients.
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TIMESTAMPS
00:00 - Introduction
04:37 - Challenges in Identifying Parathyroid Glands
12:14 - Preoperative Workup and Imaging
16:41 - Understanding Hypoparathyroidism and Hypocalcemia
23:25 - Surgical Techniques and Identifying Parathyroid Glands
33:48 - New Technologies in Parathyroid Surgery
43:15 - Challenges and Benefits of New Surgical Technologies
44:49 - Practical Applications and Personal Experiences
59:33 - Impact of Technology on Surgical Practices
01:08:40 - Final Thoughts and Continuous Learning
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RESOURCES
BackTable+ for ENT
https://plus.backtable.com/pages/ent
Dr. Singer’s profile
https://www.henryford.com/physician-directory/s/singer-michael -
Is a subtle voice change something to ignore? In this episode of the Backtable ENT podcast, hosts Gopi Shah and Dr. Ashley Agan speak with Dr. Bharat Panuganti, a laryngologist from Washington University in St. Louis, about the diagnosis, treatment, and management of early glottic cancer.
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SYNPOSIS
First, the doctors discuss the importance of not underestimating voice changes such as dysphonia. Then, they discuss the evolving demographics and risk factors of laryngeal cancers. Dr. Panuganti also explains his approach to using advanced imaging techniques and lasers in treatment. The conversation highlights the necessity of personalized and compassionate patient care, considering both surgical and radiation therapy options. The discussion concludes with advice on the importance of consistent patient follow-up for early detection and treatment of recurrences.
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TIMESTAMPS
00:00 - Introduction
03:09 - Understanding Early Glottic Cancer and Symptoms
08:09 - Physical Examination, FEES and Stroboscopy
14:19 - Intraoperative Imaging Techniques
31:33 - Radiation vs. Surgery: Predicting Outcomes
32:18 - Laser Surgery and Technologial Advances
42:51 - Robotic Surgery
47:13 - Postoperative Care and Patient Counseling
52:53 - Equitable Care and Treatment Choices
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RESOURCES
BackTable+ for ENT
https://plus.backtable.com/pages/ent
Dr. Bharat Panuganti’s WashU Profile:
https://oto.wustl.edu/people/bharat-panuganti-md/ -
From cable grafts to free muscle transfer, surgical treatments for facial paralysis are evolving quickly. In this episode of the Backtable ENT Podcast, Dr. Myriam Loyo Li, facial plastic surgeon at OHSU, joins guest host Dr. Shiayin Yang of Vanderbilt to discuss dynamic procedures for facial paralysis.
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This podcast is supported by:
BackTable + ENT
https://www.backtable.com/shows/ent
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SYNPOSIS
First, the surgeons review workup of flaccid and non-flaccid (synkinetic) facial paralysis. Then, they review the principles of facial reanimation. Topics such as nerve graft selection and staged surgery are covered. Dr. Loyo Li explains her timelines for staged surgery and how patient characteristics affect her decision planning. Finally, the surgeons discuss free muscle transfer – an exciting new technique in the world of facial plastic surgery – to treat facial paralysis.
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TIMESTAMPS
00:00 - Introduction
02:48 - Evaluating and Managing Flaccid Facial Palsy
05:18 - Imaging and Treatment Pathways
07:16 - Nerve Grafting Techniques and Preferences
10:08 - Challenges and Innovations in Facial Reanimation
25:50 - Patient-Centered Approaches and Decision Making
37:30 - Evaluating Facial Nerve Recovery
43:25 - Timing and Criteria for Nerve Transfers
46:41 - Free Muscle Transfer Techniques
49:47 - Innovations in Cross Facial Nerve Grafts
01:06:04 - Exploring Free Strap Muscle Transfers
01:14:05 - The Future of Facial Reanimation
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RESOURCES
Dr. Loyo Li’s OHSU Profile:
https://www.ohsu.edu/providers/myriam-loyoli-md-mcr
Dr. Yang’s Vanderbilt Profile:
https://www.vanderbilthealth.com/doctors/yang-shiayin -
It’s not an overstatement to say that surgeons from The House Clinic revolutionized otology / neurotology in the second half of the twentieth century. In this episode of the BackTable ENT podcast, Dr. John House, son of the clinic’s founder, Howard, discusses the clinic’s fabled history with guest host Dr. Walter Kutz (UT Southwestern).
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SYNPOSIS
Dr. House recounts his father’s journey traveling the world to learn from renowned otolaryngologists, ultimately settling in Los Angeles where he established his practice. Working with his brother William, Howard started a clinic that popularized innovative treatments for otosclerosis, acoustic neuroma, and sensorineural hearing loss. While innovations like Howard’s cochlear implant and John’s House’s House-Brackmann Facial Nerve Grading Scale faced resistance at first, they eventually won widespread acceptance. The episode concludes with Dr. Kutz’s moving personal reflection on his time as a fellow at the House Clinic.
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TIMESTAMPS
00:00 - Introduction
05:41 - Dr. Howard House’s Path to Neurotology
17:14 - Dr. Bill House’s Passion Project: The Cochlear Implant
28:39 - Development of the House-Brackmann Facial Nerve Grading System
38:49 - The Evolution of Stapes Surgery
45:14 - House Alumnus Dr. Walter Kutz’s Journey
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RESOURCES
Dr. John House’s House Clinic Profile:
https://www.houseclinic.com/home/meet-the-team/profile/john-william-house-1/
Dr. Walter Kutz’s UT Southwestern Profile:
https://utswmed.org/doctors/joe-kutz/ -
En este episodio de Backable ENT, El Dr. Carlos Torre entrevista al Dr. Luisam Tarrats, un otorrinolaringólogo de Puerto Rico, sobre su práctica médica y su viaje empresarial para construir Burble, una empresa de enjuagues nasales.
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SYNPOSIS
Primero, el episodio explora la trayectoria del Dr. Luisam Tarrats, quien decidió regresar a Puerto Rico para mejorar la oferta quirúrgica y enfrentar los desafíos tras el huracán María. Se destaca su innovación empresarial con Burble Inc., una empresa que desarrolló un sistema de irrigación nasal salina aprobado por la FDA. La conversación incluye temas como la importancia de la higiene nasal para la salud y el bienestar, estrategias para emprender en el campo médico, y el balance entre la vida profesional y personal. Se subraya la importancia de educar a médicos y pacientes sobre el uso adecuado de productos de higiene nasal y el papel proactivo de la medicina preventiva.
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TIMESTAMPS
00:00 - Trayectoria profesional del Dr. Luisam Tarrats
03:45 - Fundación y desarrollo de Burble
16:51 - Innovaciones y beneficios del producto Burble
37:40 - Educación y concienciación sobre la higiene nasal
48:03 - Equilibrio entre la vida profesional y personal
58:39 - Consideraciones legales y estructurales
01:16:54 - Consejos para emprendedores aspirantes
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RESOURCES
Burble
https://letsburble.com/ -
Surgeons are fortunate that their work is both fulfilling and well compensated. When this earning potential meets solid financial planning, personal and material satisfaction results. In this episode of BackTable ENT, Dr. Robert Puchalski (South Carolina ENT) discusses financial wellness with guest host Dr. Ayesha Khalid (Cambridge Health Alliance).
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SYNPOSIS
First, Dr. Puchalski describes the benefits and challenges of different private practice models, emphasizing the importance of market share. Then, he explores income generation beyond clinical work, including ancillary services and investment. Transitioning to personal finance, he shares financial planning strategies so that practicing medicine is a choice rather than a necessity. The episode wraps with Dr. Puchalski’s thoughts on practicing medicine.
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TIMESTAMPS
00:00 - Introduction
06:56 - Market Share: Why it Matters
10:16 - The Importance of Passive Income & Ancillaries
21:47 - Personal Finance for Physicians
28:13 - Supporting Wellness Through Financial Planning
43:11 - Final Thoughts
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RESOURCES
Dr. Robert Puchalski’s SC ENT Profile: https://www.southcarolinaent.com/providers/robert-puchalski
Dr. Ayesha Khalid’s Cambridge Health Alliance Profile: https://www.challiance.org/doctors/profile?n=899 -
Tinnitus remains one of otology’s greatest, most challenging, and unsolved clinical problems. In this episode of the BackTable ENT Podcast, Dr. Hamid Djalilian, chair of otolaryngology at University of California Irvine (UCI), joins guest host and fellow otologist Dr. Walter Kutz (UT Southwestern) to discuss contemporary tinnitus therapy.
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This podcast is supported by:
PearsonRavitz
https://pearsonravitz.com/backtable
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SYNPOSIS
First, Dr. Djalilian shares how he got interested in tinnitus. After observing how migraines and tinnitus share many similar triggers, he hypothesized that increased central sensitivity underlies both diseases. He successfully adopted migraine management strategies for his tinnitus patients and found great clinical success. After sharing pathophysiologic similarities between the two diseases, Dr. Djalilian expounds on how he evaluates and treats tinnitus. His discussion includes lifestyle modifications, medication, and emerging surgical therapies. Finally, he advises listeners to think of tinnitus as a manageable condition, rather than a poorly-understood phenomenon.
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TIMESTAMPS
00:00 - Introduction
02:34 - The Challenge of Treating Tinnitus
07:19 - Connecting Tinnitus & Migraine
15:59 - Atypical (Otologic) Migraine & Diagnostic Challenges
19:59 - Managing Tinnitus Triggers
26:27 - Dietary Triggers of Tinnitus
28:44 - The Role of Sleep Quality in Tinnitus
33:04 - Caring for Older Patients with Tinnitus
37:59 - New Therapies for Tinnitus: Sound & Cognitive Behavioral Therapy
44:08 - Neuromodulation: The Future of Tinnitus Therapy?
51:34 - Final Thoughts on Tinnitus Treatment
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RESOURCES
BackTable ENT Episode 60 Otologic Manifestations of Migraine with Dr. Hamid Djalilian
https://www.backtable.com/shows/ent/podcasts/60/otologic-manifestations-of-migraine
Dr. Hamid Djalilian University of California, Irvine Profile: https://www.ent.uci.edu/faculty/hamid-djalilian-md.asp
Dr. Hamid Djalilian’s Website:
https://hamiddjalilianmd.com/
Fan-Gang Zeng (Hearing and Speech) Lab at UCI:
https://faculty.sites.uci.edu/hesplab/
PearsonRavitz:
https://pearsonravitz.com/ -
Many of us continue to associate “Artificial Intelligence” (AI) with the worst moments in The Terminator, Ex Machina, or The Matrix. Others think first of the known ethical challenges of AI and the potential workforce disruption of widespread AI implementation in healthcare and beyond. Dr. Mas Takashima, AI expert and chair of Houston Methodist’s Otolaryngology Department, wants to change our lingering apprehensions around AI. In this episode, Dr. Takashima interviews his Houston Methodist colleague and guest host Dr. Omar Ahmed.
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SYNPOSIS
First, Dr. Takashima shares his journey from video gamer to sinus surgeon and advocate for AI in medicine. He explains relevant concepts such as Generative Preformed Transformer (GPT) and neural network. Then, he and Dr. Ahmed dive into applications of AI to ENT, which include (but aren’t limited to) analysis of CT images, prediction of surgical success, and screening of residency applications. They review the unique challenges of applying this powerful technology to healthcare and emphasize the importance of safeguarding patient privacy in the era of Big Data. Finally, Dr. Takashima challenges his fellow otolaryngologists and researchers to embrace this transformative technology.
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TIMESTAMPS
00:00 - Introduction
11:43 - AI 101
23:26 - Applications of AI in Medicine
31:21 - Current & Emerging Applications of AI in ENT
33:44 - Using AI to Improve Surgical Robotics
39:09 - AI in Personalized Medicine
46:41 - AI in Medical Education
57:23 - Ethics & AI: The Need for an Updated HIPAA
01:02:20 - The Future of AI in ENT
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RESOURCES
Dr. Mas Takashima’s Houston Methodist profile: https://www.houstonmethodist.org/doctor/masayoshi-takashima/
Dr. Omar Ahmed’s Houston Methodist profile: https://www.houstonmethodist.org/doctor/omar-g-ahmed/ -
Many doctors enjoy writing, but how does a meaningful idea become a published book? Just ask Dr. Julie Wei, director of pediatric otolaryngology at Akron Children’s Hospital and author of two books. In this episode of the BackTable ENT podcast, Dr. Wei discusses her third book “Safeguarding Physician Wellbeing” with podcast host Dr. Gopi Shah.
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CHECK OUT OUR SPONSOR
PearsonRavitz
https://pearsonravitz.com/backtable
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SYNPOSIS
First, Dr. Wei shares her journey to authorship, which grew out of her efforts as an advocate for physician wellness. Then, she delves into topics covered in her book, including personal relationships, finances, fertility, and career growth. Much like operating room time-outs, “Safeguarding Physician Wellbeing” uses checklists at the end of each chapter to provide action items for readers. Drawing from her own experience as a surgeon and writer, Dr. Wei offers practical advice for prospective authors. The podcast wraps with thoughts on the need to prioritize physician wellness in an increasingly productivity-focused healthcare system.
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TIMESTAMPS
00:00 - Introduction
02:28 - Dr. Julie Wei’s Journey to Authorship
08:17 - The Concept of Well-being
16:10 - Checklists: A Tool for Patient Safety & Surgeon Well-Being
30:59 - Empowering Trainees to Speak Up
33:41 - The Importance of Taking Time Off
39:54 - Physician Well-being in the U.S. Healthcare System
44:06 - The Process of Writing A Book
52:45 - Final Thoughts & Encouragement for Aspiring Authors
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RESOURCES
Dr. Julie Wei’s Akron Children’s Hospital Profile: https://www.akronchildrens.org/people/Julie-Wei.html
“Safeguarding Physician Wellbeing,” Dr. Julie Wei: https://www.amazon.com/Safeguarding-Physician-Wellbeing-Julie-Wei/dp/1032589892 -
Artificial Intelligence (AI) already powers search results and chat bots, but what if it could help physicians diagnose cancer? In this episode of the BackTable ENT podcast, laryngologist Dr. Anthony Law of Emory University discusses applications of AI to laryngology with host Dr. Ashley Agan and guest host Dr. Mihir Patel, also of Emory.
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CHECK OUT OUR SPONSOR
PearsonRavitz
https://pearsonravitz.com/backtable
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SYNPOSIS
First, Dr. Law discusses how he connects his passions for laryngology and machine learning as a surgeon-scientist. Before opening the conversation, he defines terms needed to understand AI in medicine. Then, he discusses his work using deep learning models to identify laryngeal cancer patients based on voice recordings. Ideally, he envisions deploying his model (which is over 90% accurate) to help primary care physicians make timely ENT referrals. Mindful of the impact technology has, Dr. Law reviews technical and ethical concerns accompanying use of AI in medicine, which include underrepresented patient groups in research, patient privacy, and safe use of technology. Finally, he offers insight into the future of AI research more broadly.
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TIMESTAMPS
00:00 - Introduction
04:18 - Understanding Deep Neural Networks
07:13 - Applications of AI in Clinical Practice
15:08 - Data Security and Privacy Concerns
25:09 - Collecting Representative Data
31:13 - Biometrics: The Future of Medicine?
39:12 - Challenges & Costs of AI
42:26 - Final Thoughts & Future Directions
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RESOURCES
Pearson Ravitz
https://pearsonravitz.com/
Dr. Anthony Law’s Emory University Profile: https://winshipcancer.emory.edu/profiles/law-anthony.php
Dr. Anthony Law Lab:
https://anthonylaw2.wixsite.com/website
“What Our Voice Reveals About Our Health,” Dr. Anthony Law at TedxAtlanta: https://www.youtube.com/watch?v=-J2W5IVCECE -
Nothing is more satisfying than draining an abscess, right? But when is medical management sufficient or even better? In this episode of the BackTable ENT Podcast, pediatric otolaryngologist Dr. John McClay joins host Dr. Gopi Shah to educate listeners on the diagnosis and management of pediatric retropharyngeal abscess (RPA).---CHECK OUT OUR SPONSORPearsonRavitzhttps://pearsonravitz.com/backtable---SYNPOSISFirst, Dr. McClay reviews the symptoms, pathophysiology, and workup of neck abscesses (including RPA) in children. When evaluating any suspected neck abscess, he uses CT results to evaluate its precise size and location. Then, he addresses the role of surgery in treatment of neck abscesses. While many patients will improve with IV antibiotics alone, he mentions that most abscesses lateral to the carotid sheath and greater than 2 cm in size require surgical drainage. Finally, the conversation shifts to cover important topics including antibiotic selection, the role of steroids, and cost-effective care.---TIMESTAMPS00:00 - Introduction03:34 - Pathophysiology & Presentation of Retropharyngeal Abscess09:54 - Physical Examination in the Child with Suspected Neck Abscess17:43 - The Importance of CT Scans31:40 - Treatment of Neck Abscesses: Antibiotics vs Surgery37:56 - The Role of Steroids in Abscess Treatment53:41 - Applying Value-Based Care as a Pediatric Otolaryngologist55:44 - Recap & Final Pearls---RESOURCESDr. McClay’s website:https://www.johnmcclaymd.com/pediatric-sinus-center/Pearson Ravitzhttps://pearsonravitz.com/McClay JE, Murray AD, Booth T. Intravenous antibiotic therapy for deep neck abscesses defined by computed tomography. Arch Otolaryngol Head Neck Surg. 2003 Nov;129(11):1207-12.Johnson RF. Emergency department visits, hospitalizations, and readmissions of patients with a peritonsillar abscess. Laryngoscope. 2017 Oct;127 Suppl 5:S1-S9.
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Rhinoplasty stands out as one of the most transformative yet technically challenging procedures in facial plastic surgery. In this episode of the BackTable ENT Podcast, rhinoplasty expert Dr. Patrick Cleveland of West Palm Beach shares his approach to the procedure with host Dr. Gopi Shah.
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SYNPOSIS
First, Dr. Cleveland addresses the initial rhinoplasty consultation, including patient history, physical exam, and photo documentation. Then, the surgeons delve into technical approaches to rhinoplasty. Tackling valuable topics including graft choices, cartilage sources for revision rhinoplasty, and tools used. Dr. Cleveland offers lessons to help any otolaryngologist improve their knowledge of this essential surgery. Finally, the episode concludes with a survey of contemporary trends in rhinoplasty.
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TIMESTAMPS
00:00 - Introduction
03:28 - Fundamentals of Rhinoplasty
04:19 - Interviewing Patients & Identifying Red Flags
10:25 - Physical Exam for Rhinoplasty
15:14 - The Importance of Photo Documentation
30:26 - Cephalic Trim & Turnover Flap Techniques
32:52 - Tip Supporting Grafts and Cartilage Harvesting
36:46 - Instruments for Rhinoplasty
39:42 - Sourcing Cartilage in Revision Rhinoplasty
49:20 - Post-operative Care & Complications
56:07 - Future Directions in Rhinoplasty
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RESOURCES
Patrick Cleveland Facial Plastic Surgery:
https://www.drpatrickcleveland.com/
Deformity, etiology, solution, sequence (DESS): Facial analysis in rhinoplasty: https://pubmed.ncbi.nlm.nih.gov/37952257/ -
Facial nerve injury affects each patient in a unique way. Accordingly, surgical treatment of facial paralysis must be meticulously planned and personalized. In this episode, Dr. Shiayin Yang, Associate Professor of Otolaryngology at Vanderbilt University, addresses management of synkinesis and static procedures for flaccid facial palsy with host Dr. Ashley Agan.
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CHECK OUT OUR SPONSOR
PearsonRavitz
https://pearsonravitz.com/backtable
---
SYNPOSIS
First, Dr. Yang reviews the difference between flaccid and non-flaccid (including synkinetic) facial paralysis. She describes her approach to facial paralysis, which includes clarifying the patient’s diagnosis and thoroughly examining the facial nerve function. Dr. Yang then transitions the conversation to surgical solutions, emphasizing dual goals of restoring symmetry and function. She divides her discussion to first tackle synkinesis and then static procedures for flaccid paralysis. Procedures discussed include Botox, brow lift, blepharoplasty, myectomy, and neurectomy as well as lower eyelid and midface procedures and temporalis tendon transfer. While surgical approaches to the two conditions differ, eye protection represents an important theme throughout. The episode concludes with Dr. Yang’s pearls for approaching these complex surgical problems and a reminder of how facial paralysis affects patients’ emotional health.
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TIMESTAMPS
00:00 - Introduction
02:36 - Understanding Flaccid & Non-Flaccid Facial Paralysis
07:13 - Botox for Facial Synkinesis
12:38 - History-Taking & Physical Exam in Facial Paralysis
15:07 - Surgical Management of Synkinesis
30:47 - Patient Counseling and Motivation
32:47 - Static Procedures for Flaccid Facial Palsy
37:26 - Nuances of Peri-Ocular Procedures
43:42 - Lower Eyelid & Midface Considerations
53:00 - Dynamic Surgery Options
56:56 - Final Surgical Pearls
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RESOURCES
Dr. Shiayin Yang’s Vanderbilt University Profile: https://www.vanderbilthealth.com/doctors/yang-shiayin
BackTable ENT Episode 151- Navigating Synkinesis: From Diagnosis to Comprehensive Care with Dr. Shiayin Yang
https://open.spotify.com/episode/1JucnHB8tNC5qRW6u82ie8?si=ba729d3f3e164d6f -
Adding allergy services to your practice can improve your comprehensive ENT care. When otolaryngologists treat allergies, they more effectively address related conditions, such as sinusitis and otitis media. In this episode, Dr. Michelle Liu, general ENT in Fairfax, Virginia, shares her wisdom on starting an otolaryngologic allergy practice with host Dr. Ashley Agan.
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CHECK OUT OUR SPONSOR
Medtronic ENT
https://www.medtronic.com/us-en/healthcare-professionals/medical-specialties/ear-nose-throat.html?cmpid=Vanity_URL_MIX_medtronicent-com_202212_US_EN_NS_ENT_FY23
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SYNPOSIS
First, Dr. Liu summarizes her journey to treating allergy as an otolaryngologist. She finds the continuity of care and personal connections that accompany allergy care fulfilling. Then, she describes the different testing and treatment modalities used in her clinic. While subcutaneous immunotherapy is more common, sublingual immunotherapy offers an appealing needle-free alternative for some patients. Finally, she explains the logistics of starting an allergy practice, including finances, continuing education, and safety considerations for immunotherapy initiation.
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TIMESTAMPS
00:00 - Introduction
03:36 - Dr. Liu’s Medical Journey: From Military Resident to Civilian Otolaryngologist
08:46 - Adding Allergy Testing to Your Practice
28:44 - Adding Immunotherapy to Your Practice
31:22 - Patient Selection & Financial Considerations
39:39 - Pediatric Allergy
45:09 - Emergency Preparedness in Allergy Clinics
49:15 - Sublingual Immunotherapy & Tablets
53:48 - Continuing Medical Education in Allergy
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RESOURCES
Medtronic ENT
https://www.medtronic.com/us-en/healthcare-professionals/products/ear-nose-throat.html
Dr. Michelle Liu’s Inova Profile:
https://www.inova.org/doctors/michelle-f-liu-md
Otolaryngology Associates’ Facebook Page:
https://www.facebook.com/otoassoc/
American Academy of Otolaryngologic Allergy:
https://www.aaoallergy.org/ -
In today’s complex healthcare landscape, how can pediatric otolaryngologists help more children access evidence-based, quality care? In this episode, Dr. Jill D’Souza, pediatric otolaryngologist at Children’s Hospital of New Orleans, discusses pediatric health equity in the Gulf South with hosts Dr. Gopi Shah and Dr. Ashley Agan.
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SYNPOSIS
First, Dr. D’Souza defines the “Gulf South” to include parts of Louisiana, Texas, Mississippi, Alabama, and the Florida panhandle. Challenges to healthcare delivery in this region include rural settings, high poverty rates, and difficulties funding out-of-state Medicaid patients. Then, using tonsillectomy and tracheostomy as examples, Dr. D’Souza explains how social factors complicate access to care. She shares her successes connecting underprivileged children to the care they need. Finally, the episode concludes with her thoughts on how interprofessional teamwork powers better pediatric ENT care.
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TIMESTAMPS
00:00 - Introduction
02:17 - Challenges in Pediatric ENT Care
05:43 - Healthcare Inequities in the Gulf South
10:38 - Tracheostomy Education in Rural, Resource-Limited Settings
21:33 - Helping Patients Tackle Financial Challenges
26:52 - Caring for All in Public Hospitals
37:57 - Keeping the Big Picture in Mind
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RESOURCES
PearsonRavitz
https://pearsonravitz.com/
Dr. Jill D’Souza’s LSU Health Profile: https://www.medschool.lsuhsc.edu/otorhinolaryngology/dsouza_jill.aspx -
What is the best way to manage an infected thyroglossal duct cyst? In this episode, hosts Dr. Gopi Shah and Dr. Ashley Agan welcome Dr. Christopher Liu, associate professor of pediatric otolaryngology at UT Southwestern, to learn about his vast experience with evaluation and management of thyroglossal duct cysts and the nuances of other congenital neck masses.
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Medtronic ENT
https://www.medtronic.com/us-en/healthcare-professionals/medical-specialties/ear-nose-throat.html?cmpid=Vanity_URL_MIX_medtronicent-com_202212_US_EN_NS_ENT_FY23
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SYNPOSIS
First, Dr. Liu describes how thyroglossal duct cysts present. Patients often become aware of their cyst when a parent palpates a midline neck mass or when the cyst gets infected. Then, Dr. Liu describes non-operative management of thyroglossal duct cysts, including antibiotics to treat infection and cases in which drainage is appropriate. The conversation proceeds to surgical strategy, with Dr. Liu describing how his approach to cyst excision evolved over the years. The episode concludes with pearls on post-operative management and potential surgical complications.
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TIMESTAMPS
00:00 - Introduction
02:53 - Understanding Thyroglossal Duct Cysts
11:48 - Managing Infected Thyroglossal Duct Cysts
14:02 - Antibiotic Choices & Drainage Techniques
21:05 - Imaging & Workup
25:39 - Surgical Approach and Techniques
27:29 - Koempel’s Technique for Thyroglossal Duct Cyst Surgery
39:04 - Surgical Complications, Risk of Recurrence, & Post-Operative Care
52:37 - Key Takeaways for Thyroglossal Duct Cyst Surgery
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RESOURCES
Dr. Christopher Liu’s UT Southwestern Profile:
https://utswmed.org/doctors/christopher-liu/
Jeffrey Koempel, “Thyroglossal Duct Remnant Surgery: A Reliable, Reproducible Approach to the Suprahyoid Region”:
https://pubmed.ncbi.nlm.nih.gov/25193588/ - Montre plus
